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i <br /> NON-IIAZARDOUS WATER TRANSPORT FORM <br /> GENERATOR CUSTOMER <br /> Narne 001WfaP t 7 G _ Name Kb R #z' 0 <br /> Address --teig 61,b°f r�l+'� .r Address 41 TO W l MD tr_e_ <br /> Src rLra �� <br /> Phone Phone q 2 7 Q <br /> DESCRIPTION <br /> Description of water _ ,Vloi ittorinjz_'VVe11 Barge water_ <br /> Volume 2 0 Units -LA-L- Container(s) !�a—:±600_ <br /> This non-hazardous waste water is monitoring o,ell purge water, axivr rsnsate, sampling equipment ansate tank <br /> ansate, combination thereof, o*as described above Descnbed water may contain dissolved hydrocarbons I certify <br /> that the above named material teas been properly described and classified according to applicable regulations, and <br /> possesses no aharactersstscs that would regw-e its handing as a hazardous waste <br /> Generator/ I r c( SAer:,4 _-6 -4-.05 <br /> Authorized Agent Print Sign Date <br /> TRANSPORTER <br /> Name Hicizatj Job No 7d76 Iy <br /> Address J Pick-up Date �T <br /> f:Ldna f�[ 5 Truck ID I <br /> Phone _ Driver <br /> gn Date <br /> DISPOSAL FACILITY <br /> Marne In Ing, Quantity 7, 10 <br /> Address l I 05 Ai ort Vvav Units gal <br /> a Vista CA Di all GAC <br /> Recei-ved by '_J <br /> Pnnt 191 � <br />